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Mid- to Long-Term Outcomes of Modified Weilby Suspension Arthroplasty for the Treatment of Carpometacarpal Osteoarthritis
William Aibinder, MD; Matthew Houdek, MD; Allen Bishop, MD; Alexander Y. Shin, MD
Mayo Clinic, Rochester, MN
Introduction: The modified Weilby suspension arthroplasty is frequently performed to treat trapeziometacarpal osteoarthritis (OA). Although it is known to provide pain relief and improve thumb function in patients, there is a paucity of data long-term follow-up. The purpose of this study was to examine the outcomes of patients who have undergone a modified Weilby suspension arthroplasty and focus on hand function and complications.
Materials and methods: One hundred modified Weilby procedures (87 patients) were performed with a minimum of 1 year of follow-up or until reoperation. Mean age at surgery was 60 years (range, 39 to 81), with 49% involving the dominant extremity. Preoperative Eaton-Littler classification was stage II in 29, stage III in 42, and stage IV in 29. Pain rating, grip and appositional pinch strength, range of motion, and radiographs were assessed pre- and post-operatively. The mean followup was 4 years (range, 1-13 years).
Results: Grip and appositional pinch strength were similar to preoperative values at final follow-up (p = 0.85 and 0.73). Radial and palmar thumb abduction improved (p = 0.06 and 0.09). Overall metacarpophalangeal (MP) joint arc of motion did not change significantly postoperatively (p = 0.56). Pain improved, with only 8% of patients reporting more severe symptoms at final follow-up. Preoperative stage IV disease was 2.4 times more likely to result in postoperative pain with activity or pain at rest. There was no association between proximal migration of the metacarpal and clinical outcomes. At final radiographic follow-up there was a 46% subsidence of the first metacarpal. Three patients were revised for instability and continued pain with revision interposition arthroplasty at 15, 19, and 92 months. There were four additional reoperations. Kaplan-Meier survival free of reoperation was estimated at 2-, 5-, and 10-years as 96%, 90%, and 82%, respectively.
Conclusion: The modified Weilby suspension arthroplasty is a durable treatment option for patients with Eaton stage II and III trapeziometacarpal arthritis, providing pain relief, reliable function, and a low complication rate. Careful evaluation of scaphotrapeziod arthritis should be performed intra-operatively and addressed to diminish post-operative complications.
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